Message on the chalkboard

Is it a matter of getting it through their thick skulls, or is it compassionate instruction on the perils and benefits of oral hygiene? We asked the teacher, and 216 hygienists let us know about their views on patient education.

Is it a matter of getting it through their thick skulls, or is it compassionate instruction on the perils and benefits of oral hygiene? We asked the teacher, and 216 hygienists let us know about their views on patient education.

Mark Hartley, Editor

Editor`s note: In July 1998, RDH asked the question, "How goes your fight as an educator?" The statistical information presented here notes the responses to the questionnaire titled, "The Plaque Stops Here!" A total of 216 readers responded to the survey.

A good talking to..

Generally, what percentage of your patients receives personalized oral hygiene instructions from you?

* 50 percent said almost all of their patients receive oral hygiene instructions

* 30 percent estimated three patients out of every four patients receive instructions

* 11 percent estimated that half of their patients receive instructions

* 8 percent estimated that one patient out of every four patients receive instructions

* 1 percent estimated that less than 10 percent of their patients receive instructions

Do you provide oral hygiene instructions before, during, or after scaling and polishing?

Editor`s note: Although the question did not suggest checking off multiple answers, many readers did anyway, indicating a variable pattern on the timing of oral hygiene instructions.

* 58 percent said during treatment

* 53 percent said afterwards

* 29 percent said before treatment

What is your best suggestion for motivating patients?

* "Tell the patient how to do something. Show the patient how to use something. Have the patient show you. Once they are clear on the right way, I think they better understand the benefits. Also, tell them they determine their level of dental health - it`s important they find that revelation on their own (with my encouragement and teaching). Ask them: How important is it that you have a healthy mouth?"

* "Have good chart entries so you can build upon previous home care instructions. Always have something new to tell them."

* "I do not like to lecture patients. I find that most people complain about that. Instead, I like to point out at least one positive aspect of their mouth before breaking the bad news. Also, knowing a person over several years seems to make a huge difference in motivation."

* "Prevention means less pain, less work, less time, and less money if they use an `ounce of prevention` as opposed to a `pound of cure.` We are here to educate and teach patients to help themselves."

* "Use their mouths as the tool and their knowledge of other`s mouths for comparison. My good friend used plaque on a cracker from a patient`s mouth and asked if he wanted a snack."

* "Fear works well as a motivator."

* "Find out what`s important to them and tailor it to their needs."

* "Make it a challenge for yourself to meet each patient at their level."

* "Try and put yourself in their place. Find a button to push that will help the patient identify how better home care will affect their lives directly and positively."

* "Keep it friendly. Do not belittle the patient or take a position of superiority. Point out the positive changes in their mouths instead of always concentrating on the negative ones."

* "Keep talking. My patients all say they like it when I talk to them on their level."

* "Flossing is something to work up to doing every day. Tell them to try to do it every other day and go from there. It seems to me that motivates them more than nagging them to start in full force ... it works!"

* "I tell patients they don`t have to floss right at the time they brush their teeth. Flossing can be done anytime they like, including while watching TV."

* "I recommend leaving the floss by the chair they watch TV in; it is easier to combine two habits than to change habits."

* "Do not scold or ridicule. Say something positive for every negative."

Now this is gonna help you learn...

Do you teach brushing in the mouth with a toothbrush or on a model?

* 90 percent said they teach with a toothbrush in the mouth

* 10 percent use a model

What tools do you routinely use as part of patient education?

Editor`s note: Readers were encouraged to "check all that apply."

* 97 percent use mirrors

* 87 percent use X-rays

* 61 percent use educational reading materials specifically designed for patients

* 61 percent use printed educational materials supplied by manufacturers

* 37 percent use intraoral cameras

* 22 percent use printed materials that they or their office designed

* 12 percent use published clinical studies

* 9 percent use educational videos

* 8 percent use camera photography

* 5 percent use educational software/CD-ROM programs

* 1 percent did not use any of the tools referred to above

Which tool is most successful in motivating patients?

Editor`s note: Readers were asked to choose only one answer. RDH then compared answers only if they indicated they used the "tool," based on the response to the previous question. Obviously, if an intraoral camera is available, it`s the "tool" of choice. If not, the mirror instrument remains the top choice.

- Mirrors - Of the 97 percent of readers who said they routinely use mirrors in patient education:

_ 58 percent said mirrors were the most successful instrument in motivating patients

_ 28 percent said the intraoral camera

_ 14 percent indicated one of the other eight answers possible - all under 4 percent

_ Intraoral camera - Of the 37 percent of readers who said they routinely use intraoral cameras in patient education:

_ 62 percent said the intraoral camera was the most successful instrument in motivating patients

_ 34 percent said mirrors

_ 4 percent indicated one of the other eight answers possible - all under 2 percent

The curtain is going down....

Based on your observations during recall appointments, estimate what percentage of your patients adheres to your instructions regarding oral hygiene care from the previous appointment?

* 38 percent estimated that half of their patients adhere to instructions

* 33 percent estimated that a quarter of their patients do

* 19 percent estimated that three-quarters of their patients do

* 10 percent said less than 10 percent of their patients do

What do you do when you encounter resistance to your suggestions?

Editor`s note: A third answer was provided, but no one checked off this option. The answer was, "The dental practice discourages routine oral hygiene instructions."

* 72 percent said they "quickly evaluate the resistance and determine a better way to motivate the patient."

* 28 percent said they "restructure or restate instructions with the assumption that original suggestions may have been unclear or confusing."

What is the most unusual question a patient has asked you during the instructional part of the appointment?

* "Will actual chlorine bleach harm my teeth? I know not to get it on the gums."

* "I use matchbook covers to clean between my teeth; is that OK?"

* "How often should I change toothbrushes? I have had mine for 12 years."

* "Can you contract HIV by using someone else`s toothbrush?"

* "Does toothpaste have sugar in it?"

* "How much do you think this gold is worth today?"

* "Are you married?"

* "Does working in patients` mouths all day make it hard for you to kiss your husband?"

* "Do you do this every day?"

* "Can you start a drive-through flossing franchise?"

* "Do you do dogs, too?"

* "Is hydrogen peroxide good for dogs, or should I use something else?"

* "Where can I get some gloves like you wear to floss my teeth?"

* "Does your boss pay you extra if all your patients floss?"

* "Can I wrap the floss around my tongue to floss with?"

You want to know about what?....

Besides routine oral hygiene instructions, which areas do you also routinely provide information on?

Editor`s note: "Multiple responses" were allowed.

* 67 percent said tongue cleaning

* 35 percent said athletic mouthguards

* 11 percent said snoring

* 38 percent said halitosis

* 52 percent said smoking cessation

* 55 percent said nutrition

What percentage of your patients inquires about the usefulness of a home care product during their appointments? The product referred to may be a toothbrush, toothpaste, rinse, or interdental aid.

* 31 percent estimated that half of patients ask about products

* 31 percent estimated that three-quarters of patients ask about products

* 24 percent estimated that one-quarter of patients ask about products

* 8 percent estimated less than 10 percent of patients ask about products

* 6 percent estimated that almost all patients ask about products

What percentage of your patients do you estimate inquire about in-office bleaching services?

* 37 percent estimated that one-quarter of patients inquire about bleaching services

* 34 percent estimated that less than 10 percent of patients inquire about bleaching services

* 21 percent estimated that half of patients inquire about bleaching services

* 5 percent estimated that three-quarters of patients inquire about bleaching services

* 2 percent said no one asks about bleaching services

* 1 percent estimated that almost all patients inquire about bleaching services

What percentage of your patients do you estimate inquire about at-home tooth-whitening products, including the current generation of "extra whitening" toothpastes?

* 36 percent estimated that one-quarter of patients inquire about the at-home toothwhitening products

* 24 percent estimated that half of the patients inquire about the products

* 23 percent estimated that less than 10 percent inquire about the products

* 14 percent estimated that three-quarters of patients inquire about the products

* 2 percent said no one asks about the products

*1 percent estimated that almost all patients inquire about the products

Does your office stock and sell oral hygiene products? If so, which ones?

Editor`s note: "Multiple responses" were allowed.

* 58 percent replied, "We dispense products or samples, but we do not sell directly to patients."

* 44 percent stock and sell fluoride

* 38 percent stock and sell powered toothbrushes

* 35 percent stock and sell interdental aids

* 33 percent stock and sell specialty toothpastes or manual toothbrushes

* 28 percent stock and sell mouthrinses

* 17 percent stock and sell retail home-care products

* 3 percent replied, "We do not dispense or sell products or samples."

Just a little bitty ol` string...

With recall patients whom you`ve treated for a number of years, do you ever decide to omit flossing instructions?

* 78 percent replied, "After a while, I may stop lecturing, but I will remind or admonish with a brief declaration that they need to start flossing."

* 17 percent replied, "I will persist with my lectures for however long it takes them to start flossing regularly."

* 5 percent replied, "After five or six appointments, you know that they`re not going to floss, so it`s pointless to bring it up."

How do you personally feel about patients who won`t floss after years of instruction from you?

* 49 percent replied, "I`m just the messenger. If people don`t want to listen to what`s good for their health, I can`t allow myself to be personally affected by their indifference."

* 45 percent replied, "I try to teach myself about `patient psychology` - whether it be seminars, books, or other resources - so that I am continually developing and experimenting with patients in order to better motivate them."

* 3 percent replied, "I feel discouraged about my abilities to motivate and teach people."

* 3 percent replied, "I feel like I`m always nagging, berating, or belittling them."

Most patients state they lack the manual dexterity to floss, don`t have the time to do it, or they just forget. Can you recall the most unique excuse you`ve heard for not flossing? What was it?

* "That`s why I come to you every three months. I can`t do it better than you."

* "It causes facial lines."

* "My wife leaves floss containers all over the house, but they each have three inches of floss left in them."

* "I just got divorced, and my wife took the floss."

* "I had dinner at my girlfriend`s house and I am trying to savor it."

* "I rinse with good booze and don`t need it."

* "I ran out of the sample floss you gave me, and I didn`t know where to buy more."

* "God did not make people to floss."

* "I have a string phobia."

* "It makes me dizzy."

* "I haven`t been able to floss since I broke my foot."

* "I have to get up early and go to the gym to work out."

* "I am so muscle-bound in my upper body that I can`t raise my arms up properly to floss."

* "I`m too tired to stand."

* "The power was out."

* "My cleaning lady never puts the floss where I can find it."

* "My child lost my floss, and I can`t find it."

* "My kids tied the dog up with my floss."

* "My dog ate my floss."

* "My brother used all the floss for his craft project at school, so I couldn`t floss."

* "My mother used to slap my hands when I put them in my mouth. As an adult, I feel uncomfortable putting my fingers in my mouth."

* "My mother won`t let me."

* "My mom won`t let me waste the floss."

* "My acrylic nails are too long."

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